OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Case Management Follow-Up Services

Policy #:

VR-03-01

Code/Rule Reference:

O.A.C. 4123-18-08

Effective Date:

07/01/21

Approved:

Deborah Kroninger, Chief of Medical Operations

Origin:

Vocational Rehabilitation Policy

Supersedes:

Policy # VR-03-01, effective 08/20/18

History:

Previous versions of this policy are available upon request

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure the requirements for providing follow-up vocational rehabilitation services are clearly detailed.

 

II. APPLICABILITY

 

This policy applies to the:

·        BWC disability management coordinators (DMC);

·        Managed care organization (MCO) staff involved in the coordination and management of the vocational rehabilitation program; and

·        Vocational rehabilitation case managers (VRCM) assigned by the MCO.

 

III. DEFINITIONS

 

See Vocational Rehabilitation Definitions.

 

IV. POLICY

A.     When an IW has retuned to work as a result of participating in a comprehensive vocational rehabilitation plan, it is the policy of BWC to provide follow-up services for a minimum of 30 days after the IW returns to work.

1.     The length of follow-up is determined by the needs of the IW to achieve stability on the job.

2.     Follow-up services may be provided concurrent with other services (e.g., on the job training, gradual return to work), provided the return to work employer is paying part of the IW’s wages.

 

B.     Follow-up services may be provided, as needed, when the return to work occurs during an assessment plan, or following a job retention plan. No concurrent services shall occur when follow-up occurs in conjunction with these plans.

 

C.    If the IW returns to work prior to the start of any vocational rehabilitation plan, the case may remain open for up to two weeks to monitor the IW’s stability on the job.

 

V. PROCEDURE

 

A.     Case Management Follow-Up Services in Comprehensive Plans

1.     When the IW returns to work, the VRCM shall submit the following to the MCO for follow-up and any other needed return to work services:

a.     Authorization Request for Vocational Rehabilitation Plan (RH-45); and

b.     Vocational Rehabilitation Progress Report (RH-46), justifying the need for services.

2.     If the VRCM determines that additional follow-up time is needed beyond the initial period requested, the VRCM shall submit a new RH-45 and RH-46 to the MCO.

 

B.     If, during an assessment plan or job retention plan, the VRCM determines that follow-up services are appropriate to ensure the IW’s stability on the job, the VRCM shall amend the assessment or job retention plan and provide justification.

 

C.    Upon the IW’s return to work, the VRCM shall instruct the IW to immediately contact the VRCM concerning any problems that might affect maintaining employment. The VRCM shall take prompt action to resolve such issues.

 

D.    If, during the follow-up period, employment is not maintained, the VRCM and the MCO shall staff the case to determine plan direction.

 

E.     The DMC shall ensure the IW is aware of provisions for living maintenance wage loss if the IW appears eligible. (See the Living Maintenance Wage Loss policy).

 

F.     For information regarding outcome payments refer to BWC’s Provider Billing and Reimbursement Manual.